HISTORY OF SURGERY: FIRST WORLD WAR HISTOIRE DE LA CHIRURGIE : PREMIÈRE GUERRE MONDIALE

The 1917 Halifax : the first coordinated local civilian medical response to disaster in Canada

Chryssa N. McAlister, MD Summary Allan E. Marble, PhD The 1917 Halifax Explosion was an unfortunate but predictable tragedy, given T. Jock Murray, MD the sea traffic and munitions cargo, resulting in sudden large-scale damage and catastrophic injuries, with 1950 dead and 8000 injured. Although generous sup- port was received from the United States, the bulk of the medical work was Accepted Nov. 8, 2017 undertaken using local resources through an immediate, massive, centrally coordinated medical response. The incredible care provided 100 years ago by Correspondence to: these Canadian physicians, nurses and students is often forgotten, but deserves C. McAlister attention. The local medical response to the 1917 disaster is an early example of 564 Belmont Ave West coordinated mass casualty relief, the first in Canada, and remains relevant to Suite 306 modern disaster preparedness planning. This commentary has an appendix, Kitchener ON N2M 5N6 available at canjsurg.ca/016317-a1. [email protected]

DOI: 10.1503/cjs.016317 n retrospect, the remarkable feature of the Halifax Explosion is that a colli- sion of its kind did not occur earlier, given the volume of military marine I traffic entering the . In 1917, the fourth year of the First World War, hundreds of Allied ships lay protected in the natural harbour by the narrow body of water between the cities of Halifax and Dartmouth, NS. One hundred years ago, on December 6 at 9:04 am, an accidental collision between the SS Imo (Norway) and the SS Mont Blanc (France) detonated in the , resulting in the world’s largest man-made, non-nuclear explosion. The immediate casualty toll was 1600 dead and 7500 wounded, and it eventually rose to 1950 dead and 8000 injured.1 Casualties were mainly on the Halifax side of the harbour because of the location and drift of the ­munitions-laden SS Mont Blanc, which caught fire, smoke rising 2000 feet into the sky, and exploded 17 minutes later.2 There was a reflex suspicion of espionage, as would be expected today, and all Germans in the area were arrested. In reality, the accidental collision and secondary explosion destroyed the city of Halifax, leaving unprepared health care providers to respond to a catastrophe of unprecedented proportions.3 Two events dominate the retold story of the Halifax Explosion: the heroic messaging by dispatcher Vincent Coleman to halt trains coming to Halifax — “Hold up the train. Ammunition ship afire in harbor making for Pier 6 and will explode. Guess this will be my last message. Good-bye boys.”4 — and the gener- ous rescue response from the United States. The disaster could not have occurred at a worse time for Halifax, as many medical and nursing staff in the the No. 7 Canadian Stationary Hospital had been deployed to France;5 all remaining local physicians, nurses and medical students mobilized immediately to treat the injured. Delayed by snow storms, American medical units arrived between Dec. 9 and 12 from the State Guard, Maine National Guard, Red Cross () and Red Cross (Rhode Island).1 The immediate care and the bulk of care thereafter was provided by Nova Scotian physicians, nurses and students, supplemented by an extraordinarily fast mobilization of physicians and nurses from the other Maritime provinces. Despite the remarkable local response, a tendency to believe that all the medical care of the wounded was

372 J can chir, Vol. 60, No 6, décembre 2017 © 2017 Joule Inc. or its licensors HISTORY OF SURGERY: FIRST WORLD WAR provided by the United States started early and has per- to Chisholm and found him alive but unconscious, bleed- sisted6 (Appendix 1, available at canjsurg.ca/016317-a1).​ ing from a head wound.8 He provided first aid and The walking wounded went to the nearest point of care. arranged for Chisholm’s transfer to the Victoria General Dr. John Cameron and the patient he was examining in his Hospital (VGH). In all, 90 physicians in Halifax and Dart- office were shielded by a large flower pot from the window mouth treated the wounded either in their clinics or local glass that was blown in by the explosion.7 His clinic was hospitals (Appendix 1). quickly overwhelmed with patients, as was that of Although the No. 7 Canadian Stationary Hospital (Dal- Dr. Lewis Thomas on Brunswick Street. Dr. Thomas was housie University) had deployed several of its finest staff, told by patients in the line that Dr. Murdoch Chisholm VGH responded with skill and resilience. Dr. George next door was probably dead. Thomas immediately went Murphy described the VGH entrance as quickly “jammed with autos, wagons, and every con- veyance capable of carrying a sufferer. The hallways, offices, and every bit of floor space was littered with human beings suffering with all degrees and manners of wounds and injuries.”1 With general surgery colleagues Drs. John MacDougall and Henry MacDonald, ophthalmologists Drs. Everind Kirkpatrick and Evatt Mathers, and anesthetist Dr. Frederick Lessel, Murphy operated for 72 hours without a break. The VGH used its 200 beds to look after 575 injured and burned patients (Appendix 1).2 In all, 10 hospitals were used dur- ing the emergency: VGH, The Hali- fax Infirmary, The Children’s Hospi- tal, The Hospital, The Cogswell Street Military Hospital, Camp Hill Military Hospital, Pier 2 Fig. 1. Unidentified doctor and nurses, in the Nova Scotia Hospital dressing burns on Military Hospital, Dr. Courtenay children injured in the 1917 Halifax Explosion. Archives Nova Scotia. Ligoure’s Private Hospital, Dr. Anthony Mader’s Private Hospi- tal and Pine Hill Convalescent Hos- pital.1 In addition, treatment centres were improvised at the YMCA, Bel- levue House, St Mary’s College, Hal- ifax Ladies College, the Waegwoltic Tennis Club and ships in the har- bour. Dalhousie medical students were pressed into service at several of these sites, overseen by surgeons, such as Dr. Murphy, who constantly travelled from one site to another.2 The Canadian Army Medical Corps supplied 56 doctors and 136 nurses from ships in the harbour. American teams set up in these improvised hos- pitals, including Dr. Ernest Codman, who though critical of hospitals in his native Boston was complimentary of the medical arrangements in the Fig. 2. YMCA where Ernest Codman and a team from Boston set up an emergency hos- pital as part of the relief effort for the 1917 Halifax Explosion. Nova Scotia Archives and YMCA. The Halifax Relief Commit- Records Management, Lola Henry Collection, No. 1979–237.8. tee was established within hours of

Can J Surg, Vol. 60, No. 6, December 2017 373 HISTOIRE DE LA CHIRURGIE : PREMIÈRE GUERRE MONDIALE the explosion in order to coordinate the complex medical vived. One hundred years later we pay tribute to the Cana- response. Later the committee would oversee reconstruc- dian physicians, nurses and students who successfully coor- tion and compensation of victims (Appendix 1).9 dinated the impressive local medical response so rarely An unintended consequence of Vincent Coleman’s emphasized in reviews of the Halifax Explosion. heroic telegraphing was the immediate notification about the disaster to all communities along the railway lines. Affiliations: From the Department of Ophthalmology and Vision Sci- ence, University of Toronto, Toronto, Ont. (McAlister); the Depart- From around the Maritimes, 153 physicians and 174 nurses ment of Surgery, , Halifax, NS (Marble); and the immediately made their way to Halifax by train to help. Faculty of Medicine, Dalhousie University, Halifax, NS (Murray). Such an extraordinary mobilization was possible because Competing interests: None declared. 90% of medical personnel was still at home, despite the fact Contributors: All authors contributed substantially to the conception, that Nova Scotia deployed 2 wartime hospitals, unlike some writing and revision of this article and approved the final version for newer provinces where more than 50% had volunteered for publication. overseas service.10 Many of these volunteers undertook gen- eral surgery, including Dr. David Hartigan from New References Waterford.11 Others provided specialist care. Penetrating eye injuries were extraordinarily prevalent in 1. Harris DF. The medical relief work of the Halifax disaster, PANS, 12 MG36, series C, 119. the Halifax Explosion because of flying glass shards. The 2. Murray J. Noble Goals, Dedicated Doctors: The Story of Dalhousie Medical smoke cloud of the ignited SS Mont Blanc rose high in the School. Halifax (NS): Nimbus Publishing; 2017. air, and women, men and children stopped to watch through 3. McAlister VC. Drills and exercises: the way to disaster preparedness. windows not knowing that minutes later the vessel would Can J Surg 2011;54:7-8. explode, shattering every window in the city.13 Dr. George 4. Vincent Coleman and the Halifax Explosion. Halifax (NS): Maritime Museum of the Atlantic; 1917. Available: https://maritimemuseum. Cox came from New Glasgow and, with 12 other ophthal- novascotia.ca/what-see-do/halifax-explosion/vincent-coleman-and-halifax- mologists, operated on 592 eyes, enucleating 249 eyes, with explosion (accessed 2017 Nov. 15). 16 double enulceations.14 Other physicians, such as 5. Leddin D, Charlebois P. Treatment of enemy wounded: evidence Dr. Avery DeWitt of Wolfville, were asked to care for from the No. 7 Canadian Stationary Hospital (Dalhousie University). patients on hospital trains evacuating wounded out of Hali- Can J Surg 2017;60:11-3. 6. Annual Report of the Victoria General Hospital for 1918. Halifax fax (see the film “Halifax Explosion: The Aftermath and (NS): VGH; 1918. p.12-15. Relief Efforts (1917),” available at www.youtube.com​ 7. Cameron J. In Reminiscent Mood. NS Med Bull 1945;24:135. /watch?v=5PImhLMxTXc; caring for the wounded on trains 8. Dr. Lewis Thomas (1874-1956). NS Med Bull 1956;35:128. begins at 4:48 of the film). DeWitt, with only the help of his 9. Halifax Relief Committee. PANS, RG14, series S, Vol. 17, 3. 75-year-old father Dr. George DeWitt and his sister Nurse 10. Da Cambra MP, McAlister VC. Calgary, Edmonton and the Univer- sity of Alberta: the extraordinary medical mobilization by Canada’s Nellie Anderson DeWitt, looked after a trainload of dying newest province. Can J Surg 2017;60:296-9. and injured patients in an improvised hospital in Truro 11. McAlister V. Louis Kristal at 100: witness to the evolution of surgery because all of the town’s doctors had gone to Halifax.1 in Canada. Can J Surg 2017;60:364-5. The medical response to the 1917 disaster is the first 12. McAlister CN, Murray TJ, Lakosha H, et al. The Halifax disaster example of local coordinated civilian mass casualty relief in (1917): eye injuries and their care. Br J Ophthalmol 2007;91:832-5. 13. Ruffman A, Howell C. Ground zero: a reassessment of the 1917 explosion in Canada, and many features of the successful response are the Halifax Harbour. Halifax (NS): Nimbus Publishing; 1994. p. 276–7. 3 echoed in modern disaster preparedness planning. Despite 14. McAlister CN, Murra TJ, Maxner CE. The Halifax Explosion of a final death toll of 1950, about 8000 of the injured sur- 1917: the oculist experience. Can J Ophthalmol 2008;43:27-32.

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